Thursday, April 9, 2015

Montana on cusp of passing Medicaid expansion

In breaking news yesterday, the Montana House of Representatives passed a Medicaid Expansion Bill to a final reading by a 54-46 vote.

The expansion called the Health and Economic Livelihood Partnership Act (HELP Act), is a slightly amended version of Senate Bill 405, which was approved in that chamber on March 30 by a 28-21 vote. The amended House version, slated for final approval today is almost certain to pass the Senate next week, after which Democratic Governor Steve Bullock will be extremely likely to sign the HELP Act into law.

The bill is slightly different from a traditional Medicaid expansion in that it will require some beneficiaries to pay co-pays; and has a job search component. However, as Section 6 of the bill notes, those co-pays will not exceed caps and regulations established by law. The job-search component (Section 14) also appears to not affect eligibility for expanded Medicaid and only asks the state labor and industry department to partner with the state health department to match up HELP beneficiaries with potential job openings.

This should get through the Federal Department of Health and Human Services with few problems.

In both chambers, a moderate Republican sponsored the bill. In the House, Democrats managed to get the bill out of a hostile committee that had bottled up both it and Bullock's own expansion proposal this year by using a legislative stratagem called the "Silver Bullet": Under a gentleman's agreement during this session that each party gets to move six bills of their choice that have been blocked in committee on to the House floor for a straight-majority vote. Eleven Republicans helped the 41 Democrats in the chamber get the bill on the floor, while 13 GOPers joined the Democrats to advance the bill to final passage.

There are four things about this that are great news:

1. Poor Democratic Representative Tom Jacobson will finally get to forget about his accidental vote that killed expansion in 2013.
2. These guys spent a lot of money on an astroturf campaign that is going to fail.
3. 29 states now will have expanded Medicaid coverage.
4. Best of all, 27,000 to 45,000 people are going to get access to health insurance.